Investigation Reveals 'Severe' White House Pharmacy Misconduct

Allegations include one doctor telling pharmacy staff to give stimulant drugs to a White House visitor as a “parting gift” and pharmacy staff handing out controlled substances without verifying the patient's identity.

Established in 1945, the White House Medical Unit is a joint service military unit under the authority of the White House Military Office. White House Medical Unit staff members include military and civilian physicians, nurses, clinical psychologists, and others chosen by the Executive Secretary of the Department of Defense.

The Unit is governed by Navy Bureau of Medicine and Surgery (BUMED) medical policies and primarily focuses on the health and safety of the President and Vice President of the United States.

It also runs a pharmacy within the White House designed to handle various pharmaceutical needs of government officials and other individuals on the sizable White House compound.

However, a government watchdog probe into allegations of inappropriate conduct by White House pharmacy officials has revealed significant and highly concerning issues with pharmacy operations.

The investigation began in 2018 when the Department of Defense Office of the Inspector General (DoD OIG) received complaints claiming that a senior military medical officer assigned to the White House Medical Unit engaged in questionable practices. The allegations included dubious actions conducted by White House Pharmacy officials.

In May 2018, the DoD OIG started investigating the complaints against the senior medical officer. Then, in September 2019, the government watchdog initiated a probe into the pharmaceutical practices of the Medical Unit's White House Pharmacy.

The DoD OIG interviewed over 120 officials and conducted site visits to observe pharmacy conduct and management practices. Although the investigation focused on events occurring from 2018 to 2020, investigators analyzed 70 interviews of former White House Military Office employees who served in the White House between 2009 and 2018. They also reviewed over 200 documents.

The final report, published on January 8, showed "severe and systemic" problems with all aspects of the White House Medical Unit's pharmacy operations. The DoD OIG says these discrepancies likely resulted from a lack of Military Health System oversight and ineffective internal controls that would ensure adherence to pharmacy safety standards.

What investigators found

Overall, the investigation uncovered a host of inadequacies, prescribing misconduct, and medication mismanagement involving not only over-the-counter drugs but also controlled substances like opioids.

According to the report, the White House Pharmacy:

• Did not accurately account for controlled substances like opioids and sleep medication and used handwritten inventory records to track these drugs. The records often contained errors, unreadable text, or crossed-out wording.
• Dispensed prescriptions for controlled substances that did not have a medical provider and patient information required by the U.S. Drug Enforcement Administration (DEA).
• Dispensed controlled medications, such as Ambien, a sedative, and Provigil, a stimulant, without verifying the patient's identity. The report shows a 2014 handwritten executive medicine policy note stating, "Executive Medicine Staff has authorization to pick up/sign for receipt of medications, including all controlled substances, without the need to present the patient's ID card."
• Allowed over‑the‑counter medications to sit in open bins for patients to pick up and use at will.
• Dispensed prescription medications, including controlled substances, to ineligible White House staff.
• Misused DoD funds by obtaining brand‑name medications instead of generic counterparts. For example, the brand names Ambien and Provigil cost the U.S. government $144,520 over a three-year timespan. The cost would have been $2,064 if the Pharmacy had utilized generics.
• Improperly disposed of controlled and non‑controlled substances in sharps containers, which violates Service guidance.
• Prioritized medical care by seniority rather than medical need, which increased the health and safety risks of non‑executive patients.
• Failed to follow DoD guidelines for verifying patient eligibility, resulting in DoD funding and care of an average of six to 20 non-DoD beneficiary patients per week.

In addition, testimonies revealed that White House Medical Unit senior officials promoted eligibility practices that did not comply with DoD guidance. Some interviewees said they were unable to act outside of these practices and could not deny requests from senior White House Medical Unit officials.

Witness testimonies

Interview transcripts of the 70 former White House Military Office staff members who were in the White House between 2009 and 2018 reveal even more concerns.

According to the report, one witness said, "Dr. [X] asked if I could hook up this person with some Provigil as a parting gift for leaving the White House."

Another witness stated, "[There] were several concerns about we're not accomplishing the mission the right way. Is stuff getting done? Yeah. Is it being done appropriately or legally all the time? No. But, are they going to get to that end result that the bosses want? Yeah."

DoD OIG Recommendations

As a result of the investigation, the DoD OIG recommended that various agencies establish more oversight and compliance with pharmacy policies.

The recommended actions include:

• In coordination with the White House Medical Unit Director, the Director of the Defense Health Agency must develop policies and procedures to manage controlled and non‑controlled medications and establish controls over White House patient eligibility.
• The Assistant Secretary of Defense (Health Affairs), along with the Defense Health Agency and the Service Surgeons General, should develop a pharmaceutical oversight plan for the White House Medical Unit and establish an oversight plan for the Unit's eligibility practices.
• The Defense Health Agency Director must develop policy and an oversight plan for executive medical services and establish procedures for billing and cost recovery for services provided to non‑military senior officials of the U.S. Government.

According to the report, the Assistant Secretary of Defense (Health Affairs) agreed to address all the DoD OIG recommendations. The watchdog agency will close their recommendations when the Assistant Secretary provides documentation demonstrating that all actions are completed.

Until then, the DOD OIG will consider the recommendations resolved and open.